ABSTRACT Perinatal outcomes in the United States consistently rank lower than other developed countries and failed to meet the Healthy People 2010 goals. Research suggests that pregnant women and their infants have improved outcomes with attention to risk and protective factors, and technology has the potential to provide comprehensive assessment and treatment of risk and protective factors during pregnancy. The purpose of this innovative, developmental grant is to develop an mHealth application that is Fast Health Interoperability Resources (FHIR) compliant to improve screening, brief intervention, and referral to treatment for pregnant women. The first aim of the proposed project includes developing a prototype mHealth technology, StartSmartTM, based upon an expanded Screening, Brief Intervention, and Referral to Treatment (SBIRT) model. Development will include consultation with expert clinicians, scientists, and patients to optimize screening of pregnant women for prenatal risk and protective factors as well as generating clinical decision support, tailored patient recommendations, and provider prompts for brief motivational interviewing counseling. SmartSmartTM will include screening, decision support, and brief interventions for the following factors: weight status and related conditions (underweight, overweight/obese, gestational weight gain, gestational diabetes mellitus), substance use (alcohol, drugs, tobacco), emotional conditions (anxiety, depression, domestic violence), and protective factors (immunizations, prenatal vitamins, physical activity, sleep). The prototype will be developed through an iterative process based upon Davis' Technology Acceptance Model and foundational needs assessments (focus groups and individual interviews) conducted by our team with providers and pregnant women. After the prototype is developed, patients and providers will be interviewed to provide feedback on SmartSmartTM. The second aim includes alpha testing and refinement of StartSmartTM based upon patient and provider feedback. The third aim is to beta test and refine based upon patient interviews and providers surveys regarding acceptability and usability. In addition, a systems engineer with workflow expertise will observe the use of StartSmartTM in the clinic setting and conduct process mapping to understand the impact on patient flow as well as workload for medical assistants and front desk staff. Future interoperability with electronic health records will be tested by establishing StartSmartTM connectivity with a publicly available and FHIR-compliant server. Use of an mHealth application based upon SBIRT has the potential to improve prenatal care with consistent screening, education, and referral for pregnant women. The proposed study addresses multiple determinants and risks at a time of life when health outcomes may be improved for two individuals: the woman who is pregnant and her unborn child.